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The following is a guest blog post by Jaime Jaimes, Instructional Writer at Conduent, Breakaway Learning Solutions). Check out all of the blog posts in the Breakaway Thinking series.
For just a moment, put yourself in the shoes of a provider who needs to work with a new EHR. You’ve known that the EHR go-live event was impending, and now it’s here. You took the training, slipped a little job aid booklet in your pocket, and think you’ve got everything under control. But once you’re on the floor, you hit a sudden roadblock. Rifling through your packet in hopes of finding an answer could waste valuable time. What you really need is a friendly face to calmly talk you through that first hurdle and get you back on track.

This scenario is the reason that some physicians are identifying at-the-elbow support as a vital part of successful EHR implementation. A confident support team can create a calm and stable environment for your staff as they learn the ins and outs of their new system. But structuring your support strategy is easier said than done. Fortunately, I was able to sit down and discuss some key go-live support elements with two of Breakaway’s client services managers: Adam Koch and Meredith Wheelock. Between them, they’ve overseen countless go-live events for hospitals and ambulatory locations alike, and they have three key pointers for any team planning a new EHR implementation or update.

Start assembling your support team early

Creating a support team is a daunting prospect. In our experience, at least a 1:3 support-to-learner ratio is the ideal level of staff training needed for a go live, a number backed up by online research journal Perspectives in Health Management. Beginning your search for the right people early on gives you the time to vet potential team members, and ensure they have the necessary certifications and experience specific to your go live. While you can get a team together in a month, we recommend starting the process two months or more before the event so that you can identify the right people and make sure they are prepared.

This may seem like a lot of time to invest, but having this at-the-elbow support can actually save you time at go live. A support team member can resolve questions and frustrating issues quickly, which in turn allows your staff to return to their other duties. Plus, the fact that the question was resolved in-the-moment, and in the environment in which your staff will likely face the issue again, increases the probability of knowledge retention and improves their confidence in using the system.

Get everyone on the same page

Even though you’re assembling a team of experts familiar with your EHR, you still need to make sure they’re all following the same workflows. This ensures your support team won’t teach different workflows to different departments or locations. Learning your best practices also means there won’t be a conflict between pre-go-live training and at-the-elbow assistance. After all, your staff expects help when they approach a support team member. If they get advice that contradicts their training, they will walk away feeling even more confused and frustrated, hindering their adoption progress. As this EHR Intelligence article notes, “Critical to the project’s success is supporting physician EHR users the right way at the right time.” Taking the time to teach your support team best practices is the easiest way to make sure you’re supporting your team the right way.

Establish lines of communication

A go-live event is a big endeavor, and even the best support team will encounter a quirk in the system they haven’t seen before. It’s at these times where having a defined path to escalate problems and share the solutions you generate will keep your EHR’s implementation on track. For those first few weeks, a daily touchpoint meeting with your support teams and site super-users can prove invaluable, as it allows everyone to identify pain points, troubleshoot issues, and come away with one clearly identified solution. Having this coordinated effort and standard way of communicating is critical for organizations large and small, and helps guarantee that even when a larger problem arises, your team doesn’t grind to a halt as you try to figure out the solution.

Your at-the-elbow support team is just one part of the successful go-live puzzle, but it’s a piece that can mean the difference between a frustrated staff and one that’s confident that this new EHR is just another part of their day.

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Conduent Company). Check out all of the blog posts in the Breakaway Thinking series.
Imagine a warehouse filled with classroom training sessions running simultaneously, hotel lobbies packed with consultants checking in and out at the same time, overrun parking lots, buses shuttling employees off campus, and more. These are the harsh, yet common challenges healthcare organizations face with classroom training – a predicament explored in the second edition of Beyond Implementation: A Prescription for the Adoption of Healthcare Technology. As the book explores the real-life headaches of classroom training, it calls on healthcare leaders and organizations to embrace a new education paradigm.

Today the healthcare industry has made considerable advances in technology. Enterprise applications now offer more features and functionality than ever before. Analytics programs, telehealth platforms, mobile health applications – each represents one of the many innovations changing the face of our industry. Yet despite these advances, classroom training remains one feature that has yet to change, a feature deeply-engrained in the habits, mental models, and beliefs of the industry. Healthcare executives already face significant pressure from making multi-million-dollar investments in clinical information systems. Changing how users are educated disrupts another component of healthcare for which executives become solely responsible, and must address and manage.

Despite the strength of the status quo, Beyond Implementation calls for healthcare’s departure from the classroom training model, as research highlights its ineffectiveness for teaching learners how to use new technology – a reason why most industries have abandoned or redesigned the model. Instead of face-to-face instruction, the book recommends healthcare organizations take a simulation-based approach to education, which provides learners with hands-on experience completing their workflows in a simulated EHR. The value of simulation-based education was first proven in the commercial airline industry. Like healthcare today, the airline industry experienced significant disruption through technology as the industry transitioned from analog to flight control systems. Unable to educate pilots quickly enough, the industry developed flight simulators that provided hands-on training that was relevant, accessible, repeatable, and sustainable. The new education model produced impressive learning outcomes, which is why the book argues for a similar model to be applied to healthcare.

Unlike classroom training, simulation-based education is more personalized and targeted. Education is role-specific and teaches learners how to complete their daily tasks in a simulated EHR environment. Users learn to complete their daily tasks according to best practice workflows guided by real-life clinical scenarios that increase relevancy, retention, and engagement. One significant benefit is users accumulate experience in the application without risks to patient safety. They also access their education at a time most convenient to them, as education is accessible 24/7 anywhere there is an internet connection. The accessibility of simulation-based education eliminates the headaches and costs of renting out warehouses, hiring trainers and consultants, scheduling staff to attend three eight-hour training sessions, and more. It’s no wonder why simulators are shown to improve confidence and knowledge in the system – which are key indicators of proficiency.

Considering the challenges and opportunities facing healthcare organizations, the need for a better education paradigm is apparent. Now more than ever, our industry is grappling with the challenges of swapping their legacy systems with new enterprise applications, which research has shown brings significantly greater challenges than the switch from paper to electronic. In addition to new strategies around leadership and other areas, organizations must provide education that helps users make the transition from old workflows, keyboard shortcuts, and habits more quickly and seamlessly. Our industry is also beginning to focus on improving outcomes through technology, a trend that requires organizations to create a workforce of proficient users efficiently and effectively.

In every aspect, healthcare stands to benefit by replacing its analog approach to education. Whether reducing costs or improving knowledge and confidence in the system, the argument for classroom training is obsolete. It’s time that our industry embrace a new model that reflects the level of innovation healthcare leaders and professionals are working so hard to adopt.

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Conduent Company). Check out all of the blog posts in the Breakaway Thinking series.
In executive conference rooms around the country, a common dialogue is emerging. In the wake of multi-million-dollar investments in electronic health record (EHR) systems, healthcare leaders are admitting that they underestimate the “care and feeding” of adopting these new applications. Whether this realization occurs from implementing a new system for the first time, or replacing an existing legacy application, the challenges are largely the same. Change fatigue, resource shortages, user resistance, workarounds, patient safety concerns – all reflect barriers healthcare leaders face adopting new healthcare technology.

The book explores several important leadership strategies that have proven invaluable to healthcare executives around the country.

Strategy #1: Establish a New Leadership Agenda

Leadership is the most fundamental driver of EHR adoption. Because of its importance to the success of the initiative, leaders must relentlessly commit to making EHR adoption a daily priority for executive teams. This includes focusing on the factors that drive optimal use of clinical information systems long after the implementation.

Strategy #2: Stop Doing List

Time is a scarce and vital asset for every executive team, which faces a host of competing priorities and time-sensitive initiatives. The most successful leadership teams prioritize the right projects that add the most value to the organization. One strategy is to develop a Stop Doing List, a concept popularized by renowned author Jim Collins. The Stop Doing List is the process of choosing which initiatives to stop in order to focus on the most crucial activities. For healthcare leaders, this means eliminating or reprioritizing enough projects to make EHR adoption among the top three priorities for the organization. To develop a Stop Doing List, Beyond Implementation recommends prioritizing initiatives per these criteria:

Projects/meetings that do not directly affect quality of care or safety

Projects/meetings that are not related to compliance or legal risk

Projects that can be delayed with little overall impact

Meetings that can be eliminated or consolidated

Strategy #3: Engage Clinical Leadership

Providers carry a powerful voice in a healthcare setting. Leaders must actively engage providers and promote their buy-in through several strategies. One strategy includes developing a provider council. Including representation from across the organization, endorsement from top leadership, and a formal charter and vision for the body, this council should oversee and govern EHR use. Another strategy is to engage members of the council to serve as champions of the effort by helping their departmental colleagues and serving as an extension of leadership.

Strategy #4: Create a Tone at the Top

Crucial to engaging users in the effort is establishing a tone that emphasizes EHR adoption. Leadership must promote awareness of the initiative by creating a value proposition and brand that connects the EHR system with the organizational vision and mission. Leadership must also establish a rhythm with their messaging and ensure it remains authentic when interacting with users. Leadership should make it a focus to answer key questions about the transition, such as how EHR adoption improves clinical and financial outcomes and how the change will affect users individually. Establishing the importance of the effort, as well as being open and transparent, helps users navigate and accept the transition more easily.

Strategy #5: Governance

Governance is also another key ingredient of effective leadership. Competing interests, differing opinions, and varying experiences all pose barriers to EHR adoption. Leadership must develop a well-defined governance process, which overcomes these barriers by creating policies and procedures that hold users accountable and define expectations and best practices around use of the system. The governance process should evolve over time to address the evolving needs of users as they adopt the application. After developing the governance process, leadership must measure its effectiveness to enforce accountability and make continuous improvements.

To improve outcomes, leadership must track the clinical and financial results of EHR adoption. Leadership should identify, select, and empower the right individuals to lead this effort. These individuals should collect, analyze, and report performance metrics that are important to caregivers and will motivate engagement and improvement.

To see improved clinical and financial outcomes, healthcare leaders must ignite and sustain the movement toward the adoption of clinical information systems. It starts with establishing a new leadership agenda that places adoption at the forefront of organizational priorities and continues through strategies that facilitate engagement, communication, governance, and measurement. When leaders engage in these activities, adoption becomes a pervasive mindset across the organization for optimal results.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Healthcare leaders and clinicians continue to be disappointed with the value Electronic Health Record (EHR) technology provides in their organizations today. The challenges are real, and it will take some time and effort to improve. The technology will continue to evolve at the pace we set as leaders, vendors and healthcare professionals.

When Free Is Expensive
Several years ago, a reputable IT vendor offered us free use of their software, which provided monitoring of equipment that would be valuable to us. Initially, we were excited; the functionality perfectly aligned with our needs, and the application was robust enough to grow with us. We had a need and the software fulfilled the need. We couldn’t wait to have access to the dashboard of data promised by the vendor.

Months after the implementation, we were still waiting. The “free” price tag was alluring, but we quickly recognized the actual maintenance costs and labor required to make the application truly valuable to our organization were far from free. This story drives home a concept that we all understand, but often overlook. Underestimating the “care and feeding” required to maintain a valuable investment puts the entire project at risk. We all need to remember the importance of sustainability even when we are initially excited about a new investment.

EHR systems are expensive and require tremendous resource investment, but the effort is ongoing and we need to plan accordingly.

The Key to Long Term Behavior Change
The difficulty of moving from implementing an EHR to maintaining high levels of adoption over the life of the application is strikingly similar to weight loss and weight management efforts. The percentage of overweight adults in the U.S. is staggering and continues to rise. Today, over 66 percent of adults in the United States are overweight and 59 percent of Americans are actively trying to lose weight. But the problem isn’t weight loss – it’s weight maintenance. Many of us have successfully lost weight, but can’t keep the weight off. As a matter of fact, we regain all the weight (and often more) within 3-5 years.

This isn’t a complex concept: dieting doesn’t incent long-term lifestyle change, thus we re-gain weight after we settle back into old habits. To be successful in the long-term, we need to practice weight management behaviors actively – for years, not months.

We’ve taken the dieting approach to implementing new software solutions in healthcare for too long. We prepare for a go-live event, but fall back into our comfortable old habits afterwards – resulting in work-arounds, regression to ineffective workflows, insufficient training for new users, poor communication and errors. The process of adoption requires a radically different discipline, and the real work begins at go-live.

Instead of checking the project off your to-do list after a successful implementation, you need to create a plan to sustain the changes. A sustainment plan addresses two critical areas:

It establishes how your organization will support the ongoing needs of the end users for the life of the application. This includes communication, education and maintenance of materials and resources.

It establishes how and when your organization will collect metrics to assess end user adoption and performance.

Lack of planning and execution in these two areas will lead to a slow and steady decline in end user adoption over time.

Effective sustainment plans require resources – time and money. Keep in mind that adoption is never static; it is either improving or degrading in the organization. A series of upgrades can quickly lead to decreased proficiency among end users, completely eroding the value of the application over time. Leadership must plan for the investment and fund it to achieve improved performance.

Most organizations only achieve modest adoption after a go-live event, and it takes relentless focus to achieve the levels of adoption needed to improve quality of care, patient safety and financial outcomes. Sustainment plans are most successful when they are part of the initial budgeting and planning stages for EHR.

Metrics Make the Difference
Metrics are the differentiating factor between a highly effective sustainment plan and one that is just mediocre. End user knowledge and confidence metrics serve as a barometer for their level of proficiency, providing the earliest indication of adoption. Ultimately, performance metrics are powerful indicators of whether end users are improving, maintaining or regressing in their adoption of the system. If we get an early warning that proficiency is slipping, we can react quickly to address the problem. These metrics ensure the organization is progressing toward high levels of adoption, overcoming barriers and gaining the efficiencies promised by EHR adoption. Metrics act just as the scale does in long-term weight management; they are the first indicator that we are falling back into old behaviors that are not consistent with sustainable adoption.

Metrics also keep us on track when performance does not meet expectations. Two potential scenarios in which the go-live event is successful but performance metrics fail to reach expectations help illustrate this idea. For instance, performance metrics could not be achieved because the system is not being utilized effectively. This may be due to inadequate training and therefore lower proficiency, or a problem with the actual performance by end users in the system. Measuring end user proficiency allows us to identify “pockets” of low proficiency among certain users or departments and make sure they receive the education needed. Once users are proficient, we can refocus our attention on the performance metrics.

A second scenario is less common but more difficult to diagnose. Users could be proficient, but specific performance metrics are still not meeting expectations. In this case, we need to analyze the specific metric. Are we asking the right question? Are we collecting the right data? Are we examining a very small change in a rare occurrence? There may also be a delay in achieving certain metrics, especially if the measurements are examining small changes. A normal delay can wreak havoc if we start throwing quick fixes at the problem. In this situation, staying the course and having confidence in the metrics will bring desired results.

Like sustained weight loss, EHR adoption is hard work. Commit to a sustainment plan and a measurement strategy to ensure your EHR continues to provide the long-term value that was promised at go-live.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

The following is a guest blog post by Heather Haugen, PhD, Managing Director and CEO at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
What is the most significant barrier to Electronic Health Record (EHR) adoption for clinicians? This question was the foundation of our research published in Beyond Implementation: A Prescription for Lasting EMR Adoption in 2010. The answer wasn’t surprising then and won’t surprise you now, but let’s consider how your leaders are doing in the face of enormous change in healthcare (think telemedicine, high pharmaceutical costs, rising medical costs, medical ID theft). It’s more important than ever to focus on technology adoption in today’s healthcare climate.

The one factor that formed a pattern across every organization struggling with EHR adoption was a lack of engagement by those leading the effort, and this still holds true today. For many reasons, this is a hard pill to swallow. First, it places responsibility back on the earliest champions: those who decided to fund and move the entire organization into an EHR implementation or upgrade. Second, it requires already overworked executive and clinical leaders to make adoption a daily priority. Effective leadership is an antecedent to adoption.

There is no greater barrier to the adoption of a complex IT application in an ever-changing healthcare environment than believing we can simply pile this effort on top of the other priorities and expect success. Organizations with disengaged, part-time, and/or overworked leaders at the helm of an EHR effort will struggle and may never achieve full adoption. In contrast, organizations with leaders who are fully invested in the daily march toward adoption will not only reach the early stages of adoption, but will enjoy a reinforced cycle of meaningful clinical and financial outcomes. Leadership must take five steps to succeed in moving their organization toward EHR adoption.

Develop a “stop doing” list: Establishing a new leadership agenda requires freeing up time for those leading and working on the effort. Without reprioritizing daily tasks, EHR adoption receives inadequate time and attention. Leaders currently in charge of EHR adoption need to understand what they are going to stop doing and focus on maintaining the courage to follow through on their decision.

Create a positive tone at the top of the organization: One of the most challenging aspects of leading an EHR adoption is transforming the project into a compelling and meaningful effort for everyone. When people, especially clinicians, believe in a cause, they will go to extraordinary lengths to ensure a successful outcome. Creating a common message with purpose and constancy is not easy, and sustaining the message is even more difficult. But when leaders create the right tone for the EHR adoption message, it will be powerful and help maintain momentum to create change.

Connect to clinical leadership: The key to provider adoption of EHRs is engagement. A governance system will engage clinicians through responsibilities and accountabilities and create clinician champions – the most highly-respected and well-networked clinicians. A high level of provider engagement can ameliorate or even overcome the common barriers to adoption, including resistance to abandoning the previous charting method, the investment of time required to learn the new system and the initial drop in productivity until users attain proficiency.

Empower decision-makers and reinforce their spheres of influence: Implementing or upgrading an EHR requires thoughtful consideration of the policies and procedures that will govern the use of the system. There are many stakeholders with a myriad of opinions and often competing interests that can dramatically slow adoption of the EHR. Adhering to a well-defined governance process ensures that the right people are involved at the right time with the right information. The lack of governance allows the wrong people to endlessly debate decisions, ignore standards and often conclude by making the wrong decisions. Leaders must establish strong governance processes that define expectations around adoption of the EHR, involve the right stakeholders to make decisions, establish policies and best practices and ultimately evaluate performance against expectations. Governance must also be flexible enough to evolve over time.

Relentlessly pursue meaningful clinical and financial metrics: The payoff for adopting an EHR comes in the form of clinical and financial outcomes. If results are neither tracked nor realized, the effort is truly a waste of time and money. Our expectations need to be realistic, but it really is the leaders who are accountable for the relentless pursuit of positive outcomes. Leaders must incent the right people to collect, analyze, and report on the data. Similar to engaging clinicians, this requires some finesse. The good news is that clinicians are generally interested in these metrics and may find the numbers compelling enough to change processes enough to impact the outcomes. Identify several key metrics that are easy to collect, work to improve them and then measure again.

Now is the time to create a new leadership agenda to drive EHR adoption and ultimately improve patient care – which is the goal we all share!

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.

The most important – and most vulnerable – connection between strategy and execution is the actual performance of people.

~ Charles Fred, Breakaway

It’s the end of football season and the Super Bowl, the game that determines the best team in the country, wait – in the world – will be played February 2 in East Rutherford, New Jersey. The more I learn about the game, the more impressive the depth of leadership, preparation, strength, training, and split-second adaption the sport involves.

First, let’s take a cue from Vince Lombardi, legendary coach of the Green Bay Packers who said that “individual commitment to a group effort – that is what makes a team work, a company work, a society work, a civilization work.”

A group is brought together by the leaders whether it’s the coach, a foreman, or an executive team. In the healthcare setting, the right tone for any change is set at the top of the organization. When adopting a major change like an EHR, leadership has the responsibility of making a game plan, getting the best people involved, and finding the right EHR education solution to help them succeed.

Education

Which brings us to training and education. Rod Marinelli, currently of the Tampa Bay Buccaneers says, “I love coaching young players and it starts with the staff that understands how to teach.” When taking on the challenge of introducing a new EHR, a hospital needs a good plan with the right trainers. A good program doesn’t try to teach every intricacy of a play in detail in order to prepare for every scenario on the field.

The same concept applies to a hospital adopting a new EHR. Dr. Heather Haugen, Managing Director at The Breakaway Group, A Xerox Company, has done significant research on EHR adoption. In Beyond Implementation: A Prescription for Lasting EMR Adoption,Dr. Haugen states that “we know from nearly nine decades of research about adult learning that humans do not learn without a natural progression from discovery through experience. The average human brain is a very poor storage device for information and data, unless that information is recalled and reinforced immediately by experiential activities.” Rather than memorization of facts and workflows, a more efficient way to learn an EHR is through simulations of those workflows. Teach the process and decision-making and the learner creates their own pathways to making the right moves.

Metrics

How do we know that the leadership coaching and the simulation training are working? By measuring the results. In football, the final score is what matters. As 20-season wide receiver Jerry Rice says, each person must take the necessary steps to reach the goal. In his words, “today I will do what others won’t, so tomorrow I can accomplish what others can’t.” Making big changes to process is difficult in execution and in motivation. But by employing the right leadership team as the “coach” along with the proper training and education, when EHR adoption is measured, the right results are possible.

Keeping Pace with Change – Sustainment

After implementing a new EHR application, it would be a mistake to assume that everything would stay the same day-to-day. Adopting an EHR rather than simply implementing an EHR indicates that an organization uses and depends on the system to make them better and more efficient. (Implementation implies only usage of the system, which leaves room for inefficiency and work-arounds.)

Once adoption is reached, it’s a continual process to stay at that level. With staff turnover, changes to software applications, and process updates, coaching, training, and keeping score fall into a plan of sustainment or the ability to keep pace with change. In the football world, Heisman Trophy winner Roger Staubach calls it dedication: “confidence doesn’t come out of nowhere. It’s a result of something…hours and days and weeks and years of constant work and dedication.” It takes continual effort to continually strive for improvement.

The Final Score

To reach the goals of excellent patient care, timeliness, efficiency, and to meet government regulations, each of these four elements must a priority, which is the definition of The Breakaway Method: Engaged Leadership, Education, Metrics, and Keeping Pace with Change. All of the pieces must be in play in order to make the most of any organization. Just as in football, the coaching staff, training program, measurements of results, and changes that meet each week’s challenges are critical.

Football does teach us that the road to success is long, to maintain success is hard, but winning is the name of the game.

Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use,
ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!

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